Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | C2-0006894 | DE |
NPI | 1104821198 |
---|---|
Provider Name | Dr. Marc Kattelman |
First Address | Ocean View, DE 19970-3217 |
Second Address | Selbyville, DE 19975-9706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D98644 | (02) |